Project Summary Consuming a healthy diet, engaging in physical activity (PA), and maintaining a healthy weight9,12,13 provide significant protection against cancer and cancer-related mortality. Given that early life patterns track into adulthood,14,15 early interventions are needed to decrease the risk of developing cancer later in life. Interventions in childcare are promising to promote healthy date, PA and obesity prevention. Implementation science has largely focused on strategies for increasing the initial adoption of programs.19 However, there is little evidence for strategies that may effectively promote the sustainability of programs. In fact, different approaches may be needed to promote the initial uptake and long-term use of evidence-based programs in community settings. A critical barrier to progress is that we do not fully understand what factors predict sustainability,18,20 and this gap in knowledge forms the premise of our current work. The overarching goals of this project are to identify predictors of fidelity and sustainability across two nutrition/PA programs for the childcare setting, to identify successful sustainability strategies from programs who have sustained on their own, and use lessons learned to develop sustainability strategies based with stakeholder input. The two programs?Food Friends 21?24 and Together, We Inspire Smart Eating (WISE)25?28?are USDA-funded nutrition education and PA programs. Food Friends has up to 20 years in the field, but use is declining; WISE has up to 6 years, and use is increasing. Like other programs, neither team has studied why some settings continue to use a program after initial adoption, while others do not. Toward our goals, we propose two specific aims: Specific Aim 1: Identify factors associated with sustaining nutrition/PA programs in childcare settings. We will use an explanatory, sequential mixed-methods design to (a) collect survey data and conduct multivariate analyses to understand predictors of sustainability and (b) conduct site visits to perform key informant interviews and validate self-reports on sustainability; identify environmental contributors to sustainability; and document program adaptations. We will also conduct interviews with external stakeholders to understand decisions affecting support for nutrition/PA programs. Specific Aim 2: Develop a multi-faceted sustainability strategy with stakeholder input. We will use evidence-based quality improvement (EBQI) sessions30?32 to engage stakeholders in developing a multi-component sustainability strategy. Data from Aim 1 on the predictors of sustainability and innovation from sites with high sustainment will be used to inform stakeholder-selected strategies. This work will provide a foundational understanding of factors that support sustainability and produce essential information to advance the study of sustainability more broadly.